Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation
File(s)MEP-D-19-00049R1-pages-11-40.pdf (1.32 MB)
Accepted version
Author(s)
Type
Journal Article
Abstract
Acute ischaemic stroke can be treated by intravenous thrombolysis whereby tissue plasminogen activator (tPA) is infused to dissolve clots that block blood supply to the brain. In this study, we aim to examine the influence of clot location and size on lysis pattern and recanalisation by using a recently developed computational modelling framework for thrombolysis under physiological flow conditions. An image-based patient-specific model is reconstructed which consists of the internal carotid bifurcation with the A1 segment of anterior cerebral arteries and M1 segment of middle cerebral arteries, and the M1 bifurcation containing the M2 segments. By varying the clot size and location, 7 scenarios are simulated mimicking thrombolysis of M1 and M2 occlusions. Our results show that initial breakthrough always occurs along the inner curvature of the occluded cerebral artery, due to prolonged tPA residence time in the recirculation zone. For a given occlusion site, lysis completion time appears to increase almost quadratically with the initial clot volume; whereas for a given clot volume, the simulated M2 occlusions take up to 30% longer for complete lysis compared to the corresponding M1 occlusions.
Date Issued
2019-11-01
Date Acceptance
2019-07-28
Citation
Medical Engineering & Physics, 2019, 73, pp.9-17
ISSN
1350-4533
Publisher
Elsevier BV
Start Page
9
End Page
17
Journal / Book Title
Medical Engineering & Physics
Volume
73
Copyright Statement
© 2019 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.sciencedirect.com/science/article/pii/S1350453319301493?via%3Dihub
Grant Number
RDB02
Subjects
Blood clot
Computational model
Drug transport
Ischaemic stroke
Thrombolytic therapy
Tissue plasminogen activator (tPA)
Biomedical Engineering
02 Physical Sciences
09 Engineering
11 Medical and Health Sciences
Publication Status
Published
Date Publish Online
2019-08-08